COVID-19: Advice for Paediatric Oncology Families

COVID-19: Advice for Paediatric Oncology Families

Questions about Coronavirus: COVID-19

Guidance updated on 26th March 2020

The Grace Kelly Childhood Cancer Trust is aware that the coronavirus situation may be causing you a great deal of worry. We understand that you may be very concerned about the situation and how it could affect your family, especially if you have a child who is receiving treatment for cancer or who has received treatment for cancer in the past.

The guidance we have released is intended for children and young people who are currently receiving cancer treatment and those who have completed treatment in the last six months. It has been based on the guidance from PHE, the government and also updated guidance from the CCLG. If your child has received a bone marrow transplant, please speak to your care team for individual advice. The UK Paediatric BMT group has produced specific guidance on this.

If you have any concerns, it is important to get in touch with your child's care team as they should be able to offer you individual advice, but we have produced this information to try and answer any questions that you may have.

What is COVID-19?

COVID-19 is an illness of the lungs caused by a new and different strain of coronavirus that was first found in China in December 2019. It has now been detected in the UK and infection with the virus is now a rapidly growing problem in many countries. Currently, the risk to the UK is being classed as high, but it is a situation that is evolving quickly.

In the UK, to date, there have been no children receiving treatment for cancer that have had a severe case of coronavirus. In the most affected regions of Italy, there have also been no documented cases of coronavirus in children.

What are the Symptoms?

For most individuals affected by the virus, the symptoms are mild. They include a dry cough, fever, flu-like symptoms or shortness of breath. Children seem to be affected more mildly than older adults. For a few individuals, the symptoms can be more severe, however.

How is COVID-19 Spread?

It is still not certain, but it is likely that the virus spreads via droplet spread when we cough or sneeze. These droplets then fall on to surfaces and are transferred to people’s hands or they breath them in directly. Therefore, good handwashing is vital to help reduce spread.

What Precautions should we take?

It is recommended by Public Health England, that everyone follows their infection control precautions below. This is especially important for children and young people that are undergoing treatment for cancer and their families. These measures include:

• Wash your hands often - with soap and water for at least 20 seconds. Use an alcohol-based hand sanitiser that contains at least 60% alcohol if soap and water are not available.

• Try to help your child avoid touching their eyes, nose, and mouth with unwashed hands where possible.

• Avoid close contact with people who are known to be unwell.

• Try and cover your child’s cough or sneeze with a tissue, then throw used tissues in the bin.

• Clean and disinfect frequently touched objects and surfaces in the home and work environment

• Regularly check the NHS website for updates on the situation.

• If you or your child develop symptoms, you should self-isolate whilst seeking medical advice as to whether to attend hospital.

The most recent government advice is that individuals with a new cough or a temperature over 37.8'C should self isolate for 7 days, however for children receiving treatment for cancer, it is important to contact your child's care team because they may require admission.

Currently there is no specific treatment available for those affected by this virus, but for most, it is a mild illness. For those more severely affected, they may require oxygen, intravenous fluids, antibiotics (if they have a bacterial infection as well) or in occasional cases, intensive care support.

At present, there is no vaccine available to prevent infection, so the best method is to try and prevent infection.

How could coronavirus affect my child who is receiving treatment for cancer?

Currently, the COVID-19 infection appears to be milder in children than in adults. However, children and young people that are undergoing treatment for cancer or who have weakened immune systems for other reasons could find it harder to fight off this and other infections.

If your child is unwell or has a fever, you should follow the guidance that you have been given by your care team. Usually this requires attending hospital if they have a fever. If in any doubt, please contact your child's team directly for advice.

If at any point you are concerned that your child has symptoms of COVID-19 or has a known COVID-19 contact, it is essential (if possible) that you inform the treating hospital before your arrival so necessary arrangements can be made. This is vital to ensure the safety of other children and families too.

What should we do if someone else in our household develops symptoms?

If someone else in your house develops symptoms such as a high temperature or a new continuous cough, the current guidance is that they should stay at home for at least 7 days after they develop the symptoms. All other members of the household, if well should, stay at home and self isolate for 14 days. The reason for this is that it is very likely that members of the same household could infect each other. By all members isolating it will help reduce the spread to other people in our community. Please remember though that self-isolation does not apply to chidren currently undergoing cancer treatment who will still need to be assessed by their care team first if they were to develop any symptoms.

Should we still attend hospital appointments and carry on with treatment?

If your child is due to be undergoing treatment, it is important that they still attend unless they are unwell. If in doubt, please contact your child’s team for more information.

In the event of any disruption to the service provided, the care team will prioritise treatment for those most in need and work to keep you informed.

Some treatment centres may choose to offer telephone or Skype consultations in some situations to reduce the need to travel to hospital for follow up. This may only be suitable in certain situations.

Can my child go to school?

On the 24th of March the government released new advice urging everyone to stay at home to prevent the spread of coronavirus even if they have no health conditions or symptoms.

The government has released guidance saying that certain groups of people (the extremely vulnerable) need shielding where possible.

Which oncology children are in the extremely vulnerable group?

The extremely vulnerable group includes all children and young people that fall in one of the following groups:

Shielding effectively means protecting them from being exposed to the novel corona virus.

If your child is in the extremely vulnerable group, then there are a series of strict measures that should be undertaken, some of which will be difficult for families to do. It is advised that the following measures are undertaken:

Strict avoidance of contact with someone that has symptoms of COVID-19 (including high temperatures or a new cough)

Not leaving the house except for essential medical visits

Home visits from nurses to provide essential support

Not attending any gatherings and not going shopping. Food deliveries should be left at the door.

What should other members of the family do?

Other members of the household need to follow the strict rules about staying at home, like the whole population but they are not required to adopt protective shielding measures for themselves.

Families should all wash their hands regularly and avoid touching their faces. They should also clean surfaces that are touched often.

Which oncology children are in the vulnerable group?

The vulnerable group includes all children and young people that fall into at least one of the following groups:

• Up to 6 months after completion of chemotherapy

• Received radiation to the whole abdomen (tummy area) or to the spleen

• If Total Body Irradiation (as part of a stem cell transplant) has been received at any time.

Children in the vulnerable group should follow the strict rules of the whole population about staying at home and staying away from other people and limiting outing and interactions. Siblings and other household members should follow the same social distancing rules. They should not be attending public gatherings and should be avoiding public places.

Although these measures are severe, they are considered necessary to keep everyone as safe as possible and to help the NHS cope with the cases that do happen.

Children that are not in the vulnerable group

Children that are not in the extremely vulnerable or vulnerable group (for example those that completed standard chemotherapy more than 6 months ago) should follow the normal rules of social distancing put in place for the whole population.

We will make every attempt to update the advice on this page, but recommend you visit Public Health England for the most up to date advice.

I have some other questions, who can I ask?

If you have any unanswered questions, please speak directly to your child’s consultant or a member of the care team in their treatment centre. They are best place to give you advice specific to your child.

We are reassured that the NHS will continue to provide cancer treatments as normal and, if it becomes necessary, prioritise some patients for hospital treatment. Cancer treatment plans would only be changed if there is no alternative.

If the pressure on the NHS grows, will my child's treatment be delayed?

We are reassured that the NHS will continue to provide cancer treatments as normal. In the event of any disruption, clinicians will always make decisions to prioritise treatment for those most in need and in consultation with patients.

If you are worried you might have been in contact with someone with confirmed coronavirus, call 111 (England, Wales and Scotland) or 0300 200 7885 (Northern Ireland).

We recommend everyone follows the NHS advice around reducing the risk of picking up infections including thoroughly washing your hands frequently, practicing good hygiene and avoiding contact with people who are unwell.

If you are advised by 111 staff or other medical professionals to self-isolate, then this would include minimising close contact with others.

The Grace Kelly Childhood Cancer Trust aims to frequently update this advice page when more information becomes available but we recommend that for the most recent and up to date advice, please see the Public Health England website.